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Similar Risk Of All-Cause Mortality With Diabetes And Coronary Heart Disease
A DGReview of :"Diabetes and All-Cause and Coronary Heart Disease Mortality Among US Male Physicians"
Archives of Internal Medicine
01/25/2001
By Mark Greener
Diabetes is associated with a similar substantial excess risk of all-cause mortality as a history of coronary heart disease, report researchers from Brigham and Women's Hospital, Boston and other US centres.
The authors based their conclusions on a prospective cohort study of 91,285 male physicians aged between 40 and 84 years.
The men were divided into four groups. Firstly, a reference group of 82,247 men without a history of either diabetes or coronary heart disease (CHD), defined in this study as a previous myocardial infarction, angina or both. Secondly, 2,317 men with a history of diabetes but no CHD. Thirdly, 5,906 men with a history of CHD but no diabetes. Finally, 815 men with a history of both diabetes and CHD.
During the five-year follow up, 3,627 people died. Of these, 1,242 men died from CHD.
Compared to those men without a history of either diabetes or CHD, the age-adjusted relative risk of all-cause mortality was 2.3 among men with a history of diabetes but no CHD. This compared to 2.2 among men with CHD and without diabetes and 4.7 among men with both conditions.
Compared to those men without a history of either condition, the age-adjusted relative risk of death from CHD was 3.3, 5.6 and 12.0, respectively. Adjusting for body mass index, smoking status, alcohol intake, physical activity did not materially alter the findings.
The authors concluded that diabetes is associated with a substantial increase in all-cause mortality and deaths from CHD. They estimated that the excess risk of all-cause mortality is of a similar magnitude to that conferred by a history of CHD.
Nevertheless, a history of heart disease is a more potent predictor of death from CHD than diabetes. Finally, the researchers concluded that patients with a history of both diabetes and CHD are at especially high-risk.
Arch Intern Med. 2001;161:242-247.
"Diabetes and All-Cause and Coronary Heart Disease Mortality Among US Male Physicians"
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